Cdn.cyfoethnaturiol.cymru



Fill in this part of the form, together with part A, the relevant parts of C3 to C7 and part F1 or F2.Please check that this is the latest version of the form available from our website. Note: If you are applying to convert your existing permit to a standard permit or add a standard facility you need to fill out form C1. If you want to make an administrative change, you should complete form C0.5.You only need to give us details in this application for the parts of the permit that will be affected (for example, if you are adding a new facility or changing existing ones). You do not need to resend any information from your original permit application.Please read through this form and the guidance notes that came with it. All relevant guidance documents can be found on our website.Contents1 About the permit2 About your proposed changes3 Your ability as an operator4 Consultation5 Supporting information6 Environmental risk assessmentAppendix 1 – Low impact installation checklist1 About the permit1a Discussions before your application If you have had discussions with us before your application, give us the case reference number or details on a separate sheet.Case or document reference 1b Permit numberPermit number this application relates to? 1c Site detailsWhat is the name, address and postcode of the site?Site name Address Postcode 2 About your proposed changes 2a Type of variationWhat type of variation are you applying for? (Please tick)Standalone water discharge activity or point source groundwater activity ?Minor technical?Normal variation?Substantial?2b Provide a non-technical summary of your applicationPlease give us brief details of all the proposed changes to current activities, and any new activities you want to add to your permit.You can use the box below, in Table 1 below. Or, you can use a separate sheet and send it to us with your application form. Tell us below the reference you have given this document.Document reference Table 1 – Details of the proposed changes 2c Consolidating existing permits into the modern styleConsolidating you permit can mean:- combining the original permit and all subsequent changes into a single document (modern permit), or- combining two or more environmental permits for the same operator and site into a single permit.Note: In both cases we may require additional information from you about, for example your management system. Therefore we would always advise you to talk to us before you submit any application to modernise or consolidate permits.2c1Do you want to have a modern style (consolidated) permit?No?Go to section 2dYes?Please note: An additional charge may apply for modernising your permit(s).2c2Identify all the permits you want to consolidate by listing the permit numbers/ versions in Table 2 below.Table 2 – Permit numbers 2d Low impact installations (installations only)Are any of the regulated facilities low impact installations?No?Go to section 2eYes?Please give us a description of your proposed activity telling us how you meet the conditions for a low impact installation and send it to us with your application form.Document reference Tick the box to confirm you have filled in the low impact installation checklist in Appendix 1 for each regulated facility.?2e Treating batteriesAre you planning to treat batteries? (See the guidance notes on part C2.)No?Yes?Tell us how you will do this, send us a copy of your explanation and tell us the reference you have given this explanation.Document reference 2f Medium Combustion Plant Are you applying to add additional new Medium Combustion Plant(s) to your existing permit No?Yes?Please complete Table 3 belowTable 3 – Adding Additional Medium Combustion Plant Number Currently permitted forNumber you wish to addMedium Combustion Plant Please complete Appendix 8 of Form C3 for each new Medium Combustion Plant you wish to add.2g Combined Medium Combustion Plant and Specified Generators2g1Are you applying to add a Specified Generator to your existing permit?No?Go to section 3Yes?Go to section 2g2 and complete Appendix 9 of Form C3 for each generator that comprises the Specified Generator.2g2Is the Specified Generator also a new Medium Combustion Plant?No?Yes?Please complete Appendix 8 and Appendix 9 of Form C3 for each new Medium Combustion Plant you wish to add that is also a Specified Generator.3 Your ability as an operatorIf you are only applying to change or add a water discharge activity, you only have to fill in question 3d.If you are applying to add waste installations or waste operations to a permit that has not previously had them, you need to fill in all of section 3.If you are applying to consolidate two or more permits or have an updated permit you must fill in question 3d.3a Relevant offences – installations, waste operations, medium combustion plant and specified generators (See guidance notes on part C2)Have you, or any other relevant person, been convicted of any relevant offence?No?Go to section 3bYes?Please give details belowTitle First name Last name Date of birth (DD/MM/YYYY) Position held at the time of the offence Name of the court where the case was dealt with Date of conviction (DD/MM/YYYY) Offence and penalty set Date any appeal against the conviction will be heard (DD/MM/YYYY) If necessary, use a separate sheet to give us details of other relevant offences, and tell us below the reference number you have given the extra sheet.Document reference 3b Technical ability - relevant waste operations only (see the guidance notes on part C2)3b1Which approved scheme are you using to show you have the suitable technical skills and knowledge to manage your facility?CIWM / WAMITAB?ESA / EU?3b2Do you already hold the relevant, formal qualifications to manage your facility?Yes?Tick to confirm you’ve included all original and continuing competence evidence.?No?Tick to confirm you’ve included evidence you’ve registered with a Scheme.?3c Finances (installations, waste operations, mining waste operations, medium combustion plant and specified generators)Do you or any relevant person have current or past bankruptcy or insolvency proceedings against you?No?Go to section 3d.Yes?Please give details of the required set-up (including infrastructure), maintenance and clean up costs for the proposed facility, against which a credit check may be assessed. Please note: We may want to contact a credit reference agency for a report about your business’s finances.Landfill, Category A mining waste facilities and mining waste facilities for hazardous waste onlyHow do you plan to make financial provision (to operate a landfill or a mining waste facility you need to show us that you are financially capable of meeting the obligations of closure and aftercare)?Bonds?Escrow account?Trust fund?Lump sum?Other?Provide a plan of your estimated expenditure on each phase of the landfill or mining waste facility.Document reference 3d Management systems (all)You can find guidance on management systems in both ‘How to Comply’ and ‘Horizontal Guidance Note 6 – Environmental Management Systems’. We have also developed environmental management toolkits for some business sectors which you can use to produce your own management system. You can get these by calling 0300 065 3000 or by downloading them from our guidance webpages.3d1Does your management system meet the conditions set out in our guidance?Yes?No?3d2What management system will you provide for your regulated facility?EC Eco-Management and Audit Scheme (EMAS)?ISO 14001?BS 8555 (Phases 1–5)?Green Dragon?Own management system?3d3Make sure you include a summary of your management system which sets out any changes or additional measures you will put in place to the address risks from the proposed changes. Tick the box to confirm you’ve done this and tell us the reference below.?Document reference Water discharge activities: Go to section 5.4 Consultation (fill in 4a to 4c for installations and waste operations and 4d for installations only)Could the waste operation or installation involve releasing any substance into any of the following?4a A sewer managed by a sewerage undertakerNo?Yes?Please name the sewerage undertaker 4b A harbour managed by a harbour authorityNo?Yes?Please name the harbour authority 4c Direct into relevant territorial waters or coastal waters within the sea fisheries district of a local fisheriesNo?Yes?Please name the fisheries committee 4d Is the installation on a site for which:4d1 a nuclear site licence is needed under section 1 of the Nuclear Installations Act 1965?No?Yes?4d2 a policy document for preventing major accidents is needed under regulation 5 of the Control of Major Accident HazardsNo?Yes?5 Supporting information5a Provide a plan or plans for the site (see guidance notes on part C2 for what needs to be marked on the plan)Document reference 5b Do any of the variations you plan to make need extra land to be included in the permit?No?Yes?Please provide a site report for the extra land.Document reference 5c Adding an installationIf you are applying to add an installation, tick the box to confirm that you have sent in a baseline report and provide a reference.?Document reference 6 Environmental risk assessment - if you need one (see the guidance notes on part C2)Provide an assessment of the risks each of your proposed activities cause to the environment. The risk assessment must use H1 or an equal method.Document reference Appendix 1 – Low impact installation checklist (see guidance notes on part C2)Installation reference ConditionResponseDo you meet this?A – Management techniquesProvide references to show how your application meets A.YesNo??References B – Aqueous wasteEffluent created m3/dayYesNo??C – Abatement systemsProvide references to show how your application meets C.YesNo??References D - GroundwaterDo you plan to release any hazardous substances or non-hazardous pollutants into the ground?YesNo??YesNo??E – Producing wasteHazardous waste Tonnes per yearYesNo??Non-hazardous waste Tonnes per yearF – Using energyPeak energy consumption MWYesNo??G – Preventing accidentsDo you have appropriate measures to prevent spills and major releases of liquids? (See ‘How to comply’.)YesNo??YesNo??Provide references to show how your application meets G.Reference H - NoiseProvide references to show how your application meets H.YesNo??Reference I - Emissions of polluting substancesProvide references to show how your application meets I.YesNo??Reference J – OdoursProvide references to show how your application meets J.YesNo??Reference K – History of keeping to the regulationsSay here whether you have been involved in any enforcement action as described in Compliance History Appendix 1 explanatory notes.YesNo?? ................
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